Welcome

Welcome to the POZ/AIDSmeds Community Forums, a round-the-clock discussion area for people with HIV/AIDS, their friends/family/caregivers, and
others concerned about HIV/AIDS. Click on the links below to browse our various forums; scroll down for a glance at the most recent posts; or join in the
conversation yourself by registering on the left side of this page.

Privacy Warning: Please realize that these forums are open to all, and are fully searchable via Google and other search engines. If you are HIV positive
and disclose this in our forums, then it is almost the same thing as telling the whole world (or at least the World Wide Web). If this concerns you, then do not use a
username or avatar that are self-identifying in any way. We do not allow the deletion of anything you post in these forums, so think before you post.

The information shared in these forums, by moderators and members, is designed to complement, not replace, the relationship between an individual and his/her own
physician.

All members of these forums are, by default, not considered to be licensed medical providers. If otherwise, users must clearly define themselves as such.

Forums members must behave at all times with respect and honesty. Posting guidelines, including time-out and banning policies, have been established by the moderators
of these forums. Click here for “Am I Infected?” posting guidelines. Click here for posting guidelines pertaining to all other POZ/AIDSmeds community forums.

We ask all forums members to provide references for health/medical/scientific information they provide, when it is not a personal experience being discussed. Please
provide hyperlinks with full URLs or full citations of published works not available via the Internet. Additionally, all forums members must post information which are
true and correct to their knowledge.

Then you are saying no one should take nPEP? There is NO difference in what he has done for only 4 days and those that take nPEP for 28 days.

Are you joking? There is an enormous difference.

When PEP works (whether or not it is "n"on-occupational PEP), the virus is killed off before it has a chance to establish itself. There is no virus left in the body to reproduce.

Resistance occurs when there is virus in the body attempting to reproduce. HIV produces a lot of variant(mutant) copies of itself when reproducing -- otherwise inferior copies that are resistant to a drug can be favored if the virus is reproducing and the drug kills off the otherwise healthier strains. The reason for 3 drug HAART is that the other active drugs kill off virus that mutates to be resistant to one drug.

But if someone has no active reproducing virus when the drug is discontinued, there is no chance of developing resistance -- if you no longer have an HIV infection, you will not develop resistance.

Giving Atripla to someone with an established infection and then ending it all at once more or less guarantees that they will be on effective monotherapy for several weeks, because an established HIV infection lingers in a number of places in the body. So it is always there trying to reproduce. While effective monotherapy doesn't guarantee resistance, but it is unwise if there is an alternative.

Finally, nPEP is not necessarily based on Atripla -- and the differential wear off time is primarily an Atripla problem.

When PEP works (whether or not it is "n"on-occupational PEP), the virus is killed off before it has a chance to establish itself. There is no virus left in the body to reproduce.

Resistance occurs when there is virus in the body attempting to reproduce. HIV produces a lot of variant(mutant) copies of itself when reproducing -- otherwise inferior copies that are resistant to a drug can be favored if the virus is reproducing and the drug kills off the otherwise healthier strains. The reason for 3 drug HAART is that the other active drugs kill off virus that mutates to be resistant to one drug.

But if someone has no active reproducing virus when the drug is discontinued, there is no chance of developing resistance -- if you no longer have an HIV infection, you will not develop resistance.

Giving Atripla to someone with an established infection and then ending it all at once more or less guarantees that they will be on effective monotherapy for several weeks, because an established HIV infection lingers in a number of places in the body. So it is always there trying to reproduce. While effective monotherapy doesn't guarantee resistance, but it is unwise if there is an alternative.

Finally, nPEP is not necessarily based on Atripla -- and the differential wear off time is primarily an Atripla problem.

Sorry for the highjack Ted

No I wasn't joking nor the use of Atripla for 4 days cause a resistence.

No I wasn't joking nor the use of Atripla for 4 days cause a resistence.

What does that even mean? It doesn't make any sense.

I hope that people who come to this thread for information they might need about Atripla and how one can develop resistance to Sustiva if it's not stopped properly don't get confused with your posts, which make no sense.

First, I want to thank everyone for all the posts and opinions. As I said, everyone who knows keeps pushing me to see a lawer, so I wanted to talk to you guys. I want to clear up some things--and some things I've learned since posting.

I went back through the hospital reports. They didn't even have me on Atripla like I thought. They just had me on Sustiva--which makes them even more irresponsible. I was thinking Atripla, because I was told I wouldn't be able to take Atripla because I resistant to it. Looking back at the papers, they only gave me the Sustiva component, which makes them even more negligent.

I was never told I was being given HIV meds. I found out when my brother and his partner recognized the name of the drug. My brother is gay as well--just 2 boys for my mom and both gay...lol. When I said outed, I meant HIV status. The hospital should have told me about the HIV meds. There was basically no contact. My attending doc would come in around midnight and wake me up every night. If ya didn't get info then, you had to wait another 24 hours. Not a good situation.

I had 2 different ID docs come see me in the hospital. They were in the room for like 2 mins and gone--guess to pick up the pay and leave. Both of them should have noticed this mistake and talked to me about the meds. These 2 got paid to see me and would know better than anyone how to prescribe HIV meds. I guess they would. I was reading most ID docs are clueless about HIV. You really need an HIV expert. I know there are many awesome docs. There are the others who do just want to get paid. I was billed for a doc who came in while I was asleep.

When I left, I was not given prescription for HIV meds. I was given an appt date to see my HIV doc, but that was like 3-4 weeks out. I didn't know much about HIV at that time--certainly didn't know about resistance issues. I didn't know stopping would cause an issue.

My CD4 in the hospital was 171. The one thing the ID doc did say was to ignore that number and it would bounce back. I think my attending doc thought he knew what he was doing with the HIV med. He was very nice and it is hard for me to be angry at him. I did get better and got out alive. I think the CD4 scared him and he thought he was doing what was right. My partner says he was like most docs--didn't want to ask for help/guidance. I did send a letter to the president/director of the hospital about the situation and that they need to do things to prevent it. I asked him to reply--just to know he got it. He never replied. It may be they are afraid of a lawsuit and doesn't want to say anything that may be used against them. It does piss me off that he would never respond. Maybe he didn't get my letter.

It sounds like most of you would possibly sue. I do feel hospitals have become like major corporations and only make changes if sued. I will keep ya updated on what I do. I'm sure the 2 year time-frame applies here on filing suit. This is a big chain of hospitals. I honestly would rather gotten a reply to my letter informing me they discussed this with all docs and nurses than to get $1. Leatherman, you're right. You must have read I'm having my first cold since that time. I guess I should make sure it is just a simple cold before suing..lol. It would be awkward to end up back there and the doc know I'm suing him. I think I would go to different hospital this time.

One more thing---As far as I've been able to tell, the hospital didn't do any genotype, phenotype, or whatever testing. They didn't do a viral load either. It would have been helpful to know viral load.

From talking to several HIV docs including Dr. Gallant and Dr. Young on their websites, 4 days of Atripla or just the Sustiva is enough to get resistant. The Sustiva or something obviously worked. When I did the first bloodwork 3-4 weeks later, my CD4 was over 1,000 and vl just 400. So, the Sustiva did something-- which is surprising with just the one drug being used. I'm going to try to get in touch with my attending doc to clear up some things. Hopefully, he'll talk to me.

I hope that people who come to this thread for information they might need about Atripla and how one can develop resistance to Sustiva if it's not stopped properly don't get confused with your posts, which make no sense.

One thing I'm confused about is why you didn't ask any questions regarding any medication that was given to you while in the hospital? I realize everyone isn't as vocal as I am, but I find it odd that someone wouldn't ask questions about what medications were being dispensed prior to swallowing it. I would imagine this question would be asked of any opposing attorney. Remember, you have rights and responsibilities in regards to your care as well as the hospital.

Also, given your history of depression, would Atripla have been a first consideration in treatment for you? One could argue there are other options as well as others down the pipeline. So what actual loss have you incurred? Also, would you be able to prove the hospital was negligent beyond a reasonable doubt?

O.k. So I've been watching too much CSI Miami and The Good Wife.

If your main objective is to bring attention to this error to the hospital so it doesn't occur to others, than perhaps a visit to the patient advocacy coordinator at the hospital would be in order.

Miss P, the reason I said the Sustiva must have done something is because it put my CD4 over 1,000 and vl at just 400. Granted, my last CD4 of 811 is great and not that big a change. My last vl was 27,000--up from 400. The Sustiva was trying to get it undetectable is what I'm saying.

As I've said in previous post, I realize my numbers are good and I realize the real, immediate problems many are dealing with right now due to bad numbers. I just wanted to say that again. I realize, right now, I don't have much to worry about. I know many have vl's in the millions and single digit CD4's.

About not asking questions: Even though I had suspected I had HIV for several years, it still was devestating news. I think we both were in a daze. My partner was facing being poz, too. He got tested and luckily was neg. As I said, my attending doc would come in at midnight. He was always in a hurry. The 2 ID docs were really in a hurry. They were in and out within 2 mins.

As I said in first post, I have not been in favor of suing. I realize I would probably lose. I would like them to make changes, so it doesn't happen again. Maybe a real HIV doc needs to come in for care when this happens. Maybe they need more focused care when someone is told they are poz or given cancer diagnosis. This is what I was trying to discuss by letter with the president of the hospital.

I just wanted to know what you guys thought. I respect your opinions. And, the dialog is often educational.

As I said, my attending doc would come in at midnight. He was always in a hurry. The 2 ID docs were really in a hurry. They were in and out within 2 mins.

Understandable. However, if you ever find yourself in the hospital again (and I truly hope you don't), realize that you are the customer (for lack of a better word). You are paying these doctors and you deserve to have all your questions and concerns answered. If that means having a family member chase the physician down the hall than that's what you do. And if that doesn't work, than you request to speak to a hospital administrator.

If the doctor didn't do his job while making his rounds; and that includes addressing any and all questions and concerns you have before he leaves, than I would definitely dispute his charges for those days when you receive the bill.

I will look into that. I probably should call the president and see if he got my letter. I called before sending to get correct name, address, etc. But, I will look into going around the president to other people within the hospital.

Yes yes Inch, you and Roddles both have enormous pensus. We're all terribly impressed.

Nao, back to the issue at hand, Ted's complaint.

Ted, have you considered the hosptial's internal disputes resolution procedures?

MtD

MtD: The only reason I persisted in responding is not because I want some sort of pissing contest but because he's giving out false information. The thread speaks for itself at this point but it would not have had his false statements regarding Atripla and resistance remained unchallenged.

And the subject matter of the back and forth is germane to the OP and his post, so it's in keeping with the "issue at hand."

MtD: The only reason I persisted in responding is not because I want some sort of pissing contest but because he's giving out false information. The thread speaks for itself at this point but it would not have had his false statements regarding Atripla and resistance remained unchallenged.

Listen babe,

I appreciate your position but I've been around long enough to know dick measuring when I see it. If you and Roddles wanna wave your massive gonads at each other that's great, but take it elsewhere. PM, another thread - wherever.

MtD: The only reason I persisted in responding is not because I want some sort of pissing contest but because he's giving out false information. The thread speaks for itself at this point but it would not have had his false statements regarding Atripla and resistance remained unchallenged.

Listen babe,

I appreciate your position but I've been around long enough to know dick measuring when I see it. If you and Roddles wanna wave your massive gonads at each other that's great, but take it elsewhere. PM, another thread - wherever.

This thread is about Ted and his issue.

Why don't we focus on that?

MtD

Excuse me, but discussing whether stopping Atripla can cause resistance is very much in keeping with the subject of this thread. The discussion is very much a part of Ted and his issue.

It seems he has received a less than appropriate standard of care and he should indeed pursue further action. My advice to Ted is that he should investigate what options the health care service he attended has to resolve this matter.

If those options don't pan out, then he might want to lawyer up and avail himself of his legal rights.

Well intentioned as you are Inch, this extended hair pulling about Atripla resistance seems both undue and tangential to the matter before us.

With that said, my advice to Ted remains the same - check out your options with the health care provider first. If they don't work out - call the shysters.

One thing I'm confused about is why you didn't ask any questions regarding any medication that was given to you while in the hospital? I realize everyone isn't as vocal as I am, but I find it odd that someone wouldn't ask questions about what medications were being dispensed prior to swallowing it.

What would a reasonable person do in this situation?: I'm in the hospital for an emergency; I was just told that I have HIV; a doctor, someone from whom you are supposed to rely on for advice and counsel, gives you a drug to take because of your dire situation. Do I not take it and go online to investigate whether it will cause resistance (have I even heard about "resistance" at this point?) only to be confronted with contradictory information like has been on this thread? In this situation, I would find it difficult to say it was contributorily negligent to take medicine given to you by an ID specialist.

If that were even true, nPEP for 28 days would sure screw up a lot of people. Which we know is not the case.

nPEP for 28 days cant cause resistance if it works there is no virus left duh. I assume you are speaking about where it does not work. So then the HIV infection that is established would be resistant? And you are saying not. Interesting. Has that actually been researched?

Logged

ďFrom each, according to his ability; to each, according to his needĒ 1875 K Marx

While you probably will need to go through the hospital appeals process, I'd check out legal advice first, were I in your shoes.

I differ from the esteemed damned one here, but sometimes, in the US at least, companies have been known to use those appeals processes to get people to make statements that could later come back to haunt them in court. It wouldn't hurt to see if there is free legal assistance through your ASO and to talk to them, before you go back to the hosppital.

What would a reasonable person do in this situation?: I'm in the hospital for an emergency; I was just told that I have HIV; a doctor, someone from whom you are supposed to rely on for advice and counsel, gives you a drug to take because of your dire situation. Do I not take it and go online to investigate whether it will cause resistance (have I even heard about "resistance" at this point?) only to be confronted with contradictory information like has been on this thread? In this situation, I would find it difficult to say it was contributorily negligent to take medicine given to you by an ID specialist.

Negligence usually needs to be proved by a preponderance of the evidence ("more likely than not" or 51% likely) or, rarely, by clear and convincing evidence

The OP mentioned he didn't find out he was given Sustiva until AFTER the fact. This is what I find odd. The fact that someone would place a pill into their mouth without any questioning as to what is being dispensed to them. The op also mentions he was surrounded by friends and family, two of which are in the medical community and somewhat familiar with HIV medications. So, he did have access to someone to advocate on his behalf.

If I had not asked questions about what medication was being administered to me while I was in the hospital than I also would have been placed on HIV meds without my authorization. I excercised my responsiblity as a patient to ask questions regarding my own healthcare and then excercised my right to refuse such treatment.

The op also admits here that he may not have faired well on Atripla due to his history of depression. So what would the actual loss be? Especially when there are other meds available with others in the pipeline.

I can't help but believe that the national patient's bill of rights along with the hospitals own patient's rights and responsibilities which are signed at the time of admission would play somewhat of a role during a case of this type. Let's be honest, a patients rights and responsibilities are put into place to protect the hospital and it's staff as much as it is to protect the patient.

I'm not saying the op is completely to blame. However, I do believe he didn't fully take advantage of his rights and responsibilities as a patient. So couldn't a court of law find negligence on behalf of both parties?

I presume you agree the op wouldn't be able to prove negligence beyond a preponderance of the evidence since you stated you wouldn't take on his case.

EDITED...Please disregard that last paragraph. After reviewing the thread I realize it was another member who was an atorney as well as stated he wouldn't take on the case. Sorry!

I'm obviously not an attorney, so I find your feedback to this thread rather interesting.

It seems he has received a less than appropriate standard of care and he should indeed pursue further action. My advice to Ted is that he should investigate what options the health care service he attended has to resolve this matter.

If those options don't pan out, then he might want to lawyer up and avail himself of his legal rights.

Well intentioned as you are Inch, this extended hair pulling about Atripla resistance seems both undue and tangential to the matter before us.

With that said, my advice to Ted remains the same - check out your options with the health care provider first. If they don't work out - call the shysters.

Regards,

MtD

A less appropriate standard of care that happens to hinge on whether it was correct procedure to have given him Atripla for four days, likely causing resistance to Sustiva. (Later corrected by the OP to say it was Sustiva alone and not Atripla that he was given). The question was should he or should he not sue for that specific reason, it has very much to do with the matters at hand.

The OP mentioned he didn't find out he was given Sustiva until AFTER the fact. This is what I find odd. The fact that someone would place a pill into their mouth without any questioning as to what is being dispensed to them.

You make great points and ones that any defense attorney would make; I was just playing devil's advocate to a degree.

I'm not saying the op is completely to blame. However, I do believe he didn't fully take advantage of his rights and responsibilities as a patient. So couldn't a court of law find negligence on behalf of both parties?

Yeap, depending on the jurisdiction (only in a very few now) a plaintiff could receive NO remedy if he is negligent in any way (1%). Most, however, use comparative negligence (or some variation of it) to apportion fault (25% to 75%) and would make an award accordingly.

I presume you agree the op wouldn't be able to prove negligence beyond a preponderance of the evidence since you stated you wouldn't take on his case.

I wouldn't take it because I only know enough about medical malpractice law to post on forums I always recommend someone who has a concern to consult with an experienced med mal attorney for a consultation - many will give free consultations on a matter such as this.

A less appropriate standard of care that happens to hinge on whether it was correct procedure to have given him Atripla for four days, likely causing resistance to Sustiva. (Later corrected by the OP to say it was Sustiva alone and not Atripla that he was given). The question was should he or should he not sue for that specific reason, it has very much to do with the matters at hand.

It's puzzling why you're (inappropriately) trying to "moderate" this.

Puzzled as you might choose to be, the pertinent issue here (as I have stated previously) is a question of the general standard care offered to Ted.

That, I fancy, has been addressed as far as this forum is able to address such things.

You suggest I am attempting to moderate this discusssion. I reject the premise of your assertion and I am not inclined to engage you further with regard to this matter in a public setting.

You are always welcome to email me if you wish to further this exchange. You will find my email address in my profile.

A less appropriate standard of care that happens to hinge on whether it was correct procedure to have given him Atripla for four days, likely causing resistance to Sustiva. (Later corrected by the OP to say it was Sustiva alone and not Atripla that he was given). The question was should he or should he not sue for that specific reason, it has very much to do with the matters at hand.

It's puzzling why you're (inappropriately) trying to "moderate" this.

Puzzled as you might choose to be, the pertinent issue here (as I have stated previously) is a question of the general standard care offered to Ted.

That, I fancy, has been addressed as far as this forum is able to address such things.

You suggest I am attempting to moderate this discusssion. I reject the premise of your assertion and I am not inclined to engage you further with regard to this matter in a public setting.

You are always welcome to email me if you wish to further this exchange. You will find my email address in my profile.

MtD

Do you have any idea how thoroughly unpleasant you come across? Not just on this thread but in general? I suppose not. But maybe you do, what with that "Hyena - Nature's Asshole" banner, is this a hint of what people should expect from you and your posts?

Do you have any idea how thoroughly unpleasant you come across? Not just on this thread but in general? I suppose not. But maybe you do, what with that "Hyena - Nature's Asshole" banner, is this a hint of what people should expect from you and your posts?

"You are always welcome to email me if you wish to further this exchange. You will find my email address in my profile."

I just read this thread, and I would like to bring up some things that nobody has mentioned yet.

First off, when you put something in your mouth, especially a drug, without asking all the questions that should be asked about said drug, becomes your responsiblity "legally", at least as far as the Pharma is concerned. Remember, doctor's advice ends with our placing anything in our mouths without checking first.

Secondly, and probably more important is the stress, and negative impact on your immune system, will probably cause you far more issues with your numbers than you can immagine at this point, and you might very well have to start meds sooner than later as a result. Are you ready for two or three years of stress, because of something you might have failed to do? Remember, Pharma, and hospitals have far more, and less scrupulous teams of attourneys, than you can probably afford. My suggestion is to learn from it and move on. The experience will be far more valuable in the future, as you fight this disease, than any amount of money, or satisfaction you might reap from a suit.

If you decide that a suit is a good alternative however, check with your ASO for your states' "legal aid". Most large universities have one as part of their legal internship.

cites please

A (finding this highly unlikely to be correct advice in the given situation -- too many plaintiffs have won too many suits to the contrary)

LOL I always thought it was Itchingblue instead of Inchlingblue. Damned dyslexia!

I think it's a movie or song, can't remember which. David, I have it worse than you though, for some reason I get him mixed up with livedbythemoon. I don't know why, perhaps they joined around the same time.... both good people in my book.

Ted, have you learned much here? I hope so, because this thread is a prime example of how your friends here at AM can really stretch something out beyond belief. Don't fret though it all comes from a good place. I hope you are feeling better today.

A (finding this highly unlikely to be correct advice in the given situation -- too many plaintiffs have won too many suits to the contrary)

Assurbanipal,I adjusted my original post, to pay defference to your exquisite professional inquisition. I have no business posting anything here anymore, I am neither a doctor or a lawyer. I see that many of the newer infected have far more experience in both the law and HIV, so my opinions are obviously just noise here.

Thanks for the heads up.

Logged

The Bible contains 6 admonishments to homosexuals,and 362 to heterosexuals.This doesn't mean that God doesn't love heterosexuals, It's just that they need more supervision.Lynn Lavne

David, I have it worse than you though, for some reason I get him mixed up with livedbythemoon. I don't know why, perhaps they joined around the same time.... both good people in my book.

Interesting that you should say that, I get you and Miss Philicia mixed up all the time .

Logged

"I have tried hard--but life is difficult, and I am a very useless person. I can hardly be said to have an independent existence. I was just a screw or a cog in the great machine I called life, and when I dropped out of it I found I was of no use anywhere else."

I want to thank everyone again for their thoughts. I've read them a few times. The arguing could get out of hand, but a good debate may bring out valuable info.

I just want to say again-- If I were to ever get sick again, I would, or someone, would be checking everything. It is a good idea anyway, since something like 100,000 people die each year from medical mistakes. I think it is important to remember that I was very ill with pneumonia. I was so weak that I couldn't make it to the bathroom. I was also on pain killers. I just assumed all the meds were for treating the pneumonia. I assumed they would have told us if they were going to start me on HIV meds. I know what they say about people who assume. My partner was just as naive. While my brother and his partner are in the medical profession, I was not going to tell them my newly found status. As I said, they recognize the name of the drug and asked me why I was being given HIV meds. This is how I learned on was on HIV meds. I didn't want to discuss it with them and was not going to get them involved in asking why I'm on HIV meds. I didn't want them to know in the first place-- at least not then.

As to the argument on whether 4 days would cause resistance: Dr. Young, Dr. McGowan, Dr. Gallant, and docs in my own practice have told me 4 days could cause resistance. So, I don't know. I do appreciate everyone who took the time to give their opinions. I guess I need to do some soul searching on what is right. I'm mainly just concerned with how people are treated in hospitals after being told they are poz.

Ted, don't beat yourself up about assuming the doctors were doing the right thing. If you're someone who never had to deal with a major illness before you got sick, it's perfectly natural that you would trust your doctors. I think it's probably safe to say that most of us here did the same until we had some sort of wake-up call, just like you did. I know I trusted doctors to "know best" until I ended up being coerced into a totally unnecessary c-section. Ever since then I question, question, question!

I don't know if suing would be the best course of action for you, taking into consideration your existing anxiety issues. It could turn out to be like throwing petrol on the fire. However, it would be a good thing if you tried to bring attention to this ghastly error in some other, more productive way. Good luck, you've got my support whatever course of action - or even inaction - you decide is best for you. Maybe your brother and/or his partner could help point you in the right direction, now that they know about the hiv anyway. They may be very good allies.

"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts